Analysis: 5 insights into 'webside' manner

Physicians using telemedicine must focus on a variety of seemingly tiny behavioral cues to effectively engage remote patients, according to an analysis published in Wired Oct. 26.

This skillset — commonly called "webside" manner, a take on traditional bedside manner — adds an additional layer of consideration that may trip up established physicians. "There are some people who are great in person and you put them on camera they're a dead fish," Elizabeth Krupinski, PhD, associate director of evaluation for the telemedicine program at Tucson-based University of Arizona, told Wired.

Here are five things to know about how webside manner impacts physician and patients.

1. An effective telemedicine session begins with high-quality technology, which comprises webcam resolution and internet connection, Dr. Krupinski noted. There are also additional considerations — involving lighting and backdrops — to ensure the video images appear clearly to the patient.

2. Some hospitals have designed on-premise telemedicine clinics to facilitate patient-physician communication. The telemedicine clinic at Sacramento, Calif.-based UC Davis Health, for example, not only has video-friendly lighting and backdrops, but also ensures privacy, so a physician can listen to a patient without headphones.

"We try our best to control as much of the environment as we can, so the doctors can be doctors," Jim Marcin, MD, director of the pediatric telemedicine program at UC Davis and division chief of pediatric critical care at Sacramento-based UC Davis Children's Hospital, told Wired.

3. Perhaps even more importantly than these technical considerations, behavioral cues also prove a major concern for remote physicians. While an in-person patient might not notice if their physician slouches or fidgets, these habits often become more pronounced on a video screen.

"It sounds strange, but when you're on camera all your actions are magnified," Dr. Krupinski told Wired. "You turn away to make a note, and now all your patient sees is your shoulder. Maybe you disappear from the frame entirely."

4. One potentially counter-intuitive recommendation Dr. Krupinski suggested is for physicians to disable the feature that presents their own face within their video chat window to ensure they focus on the patient, rather than on their own mannerisms. Physicians should also aim to look directly into the webcam whenever possible, rather than attempting to make eye-contact with the patient as displayed on their screen, according to Wired.

5. While cultivating webside manner can be difficult, David Steinhorn, MD, director of palliative care at Washington, D.C.-based Children's National Medical Center, told Wired it can lead to impressive uses of technology in healthcare.

"My experience is that, once you get past some initial hurdles, you can maintain an intimate, immediate connection with patients that in some cases may be more therapeutically useful than even in-person interactions," Dr. Steinhorn said.